OBJECTIVE: to use empirical data to assess the theoretical relevance of using a salutogenic, instead of a pathogenic, perspective to prevent smoking during pregnancy. DESIGN: quantitative study, a questionnaire was completed during the first trimester of pregnancy and an interview was conducted after the baby was born. SETTING: a geographically defined area in the south-east of Sweden. PARTICIPANTS: all 395 women in the study area who were pregnant during the study period 1994-1995. FINDINGS: the women were categorised according to their smoking habits. A significant difference in the sense of coherence (SOC) score was shown between smoking and non-smoking women in indicators of bad health. Women who relapsed to smoking showed a lower level of SOC, particularly in the manageability component, than others. The SOC score was higher in the whole study group than in other comparable, non-pregnant populations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a salutogenic perspective could be used in antenatal care as a basis for encouraging pregnant women to stop smoking. This could enhance the SOC by making smoking more understandable for the woman, by discussing smoking as a way of coping, and by encouraging the woman's own capacity and motivation to stop smoking. Starting a dialogue about smoking from the woman's point of view could do this, with the midwife and the woman exploring together the woman's thoughts about the smoking problem.

Background: The objective of this study was to assess different smoking patterns during and after pregnancy and relate these patterns to socioeconomic conditions and different health issues such as symptoms, drug consumption and health care use. Methods: The study group included 337 pregnant women from a district in south Sweden. A questionnaire was filled in during the first part of pregnancy and an interview was conducted after the baby was born. The women were categorised according to their smoking habits. Results: The categories defined were continuers, relapsers, decreasers, quitters and non-smokers. Among relapsers three symptoms, difficulty in relaxing (OR 4.48), restlessness (OR 9.59) and dysphoria (OR 3.98), were more common than among non-smokers. All three musculoskeletal symptoms were most common among continuers. Among quitters the OR for backache was 2.05, for numbness In the arms and legs 2.76 and for tearfulness 2.92. Educational level was relatively high among quitters and few had a smoking partner. Among smokers (decreasers, relapsers and continuers) 24% used drugs regularly, compared to 5% among non-smokers. Conclusions: To prevent smoking during pregnancy awareness of the relations between different smoking categories and symptoms could make it easier for hearth personnel to individualise support. A possible starting point is to discuss how to cope with different symptoms occurring during smoking cessation. Women with predictors for continued smoking during pregnancy, such as low education, unemployment, a smoking partner and multiparous, should be focused on more intensively and preventive strategies suitable for their special needs should be developed.

OBJECTIVE: to describe the qualitatively different ways in which midwives make sense of how to approach women smokers. DESIGN, SETTING AND PARTICIPANTS: a more person-centred national project 'Smoke-free pregnancy' has been in progress in Sweden since 1992. Using a phenomenographic approach, 24 midwives who have been regularly working in antenatal care were interviewed about addressing smoking during pregnancy. FINDINGS: four different story types of how the midwives made sense of their experiences in addressing smoking in pregnancy were identified: 'avoiding', 'informing', 'friend-making', 'co-operating'. KEY CONCLUSION: the midwives' story types about how they approached women who smoke illustrated the difficulties of changing from being an expert who gives information and advice to being an expert on how to enable a woman in finding out why she smoked and how to stop smoking. IMPLICATIONS FOR PRACTICE: health education about smoking that is built on co-operation and dialogue was seen by the midwives as a productive way of working. The starting point should be the lay perspective of a woman, which means that her thoughts about smoking cessation are given the space to grow while she talks.

In general, most women are familiar with the need to stop smoking when they are pregnant. In spite of this, many women find it difficult to stop. Using a phenomenographic approach, this study explored Swedish pregnant and post-pregnant women's ways of making sense of smoking during pregnancy. A total of 17 women who either smoked throughout pregnancy or stopped smoking during pregnancy were interviewed. Five different story types of how they are making sense of smoking during pregnancy were identified: smoking can be justified; will stop later; my smoking might hurt the baby; smoking is just given up; smoking must be taken charge of. Based on the study it is argued that the approach used in health education in relation to smoking cessation in antenatal care needs to move from information transfer and advice-giving to the creation of a dialogue. The starting point should be the woman's knowledge, concerns, rationalizations and prejudices. A model is suggested in which a woman may move in a space on three axes depending on life encounters, dialogue and reflections on meaning. The goal in health education would be to encourage movement along three axes: 'increase of self-efficacy towards control', 'increase awareness by reflection on meaning of the smoking issue' and 'avoidance of defense of the smoking behavior'.

Asperger´s syndrome is a state with certain difficulties in social relations, communication and perception. People with Asperger´s syndrome often have a special interest for a certain topic. The main purpose of this study was to describe how grown people with Asperger´s syndrome make sense of living with Asperger´s syndrome. The inquiry was based on semi-structured interviews with eight persons with Asperger´s syndrome. We reached those subjects trough interest organisations for people with Asperger´s syndrome. The results showed that the subjects did not experience Asperger´s syndrome as a disability, rather they mentioned it as a personality trait. Since Aspergers syndrome is not visible, the surrounding has difficulties to understand the behaviour connected to this condition. This is one of the reasons why people with Aspergers syndrome have problems on the labour market. People with Asperger´s syndrome are at risk of being stigmatised because of their deviant behaviour and the surrounding sometimes treat them condescending. The subjects thought that it is important that professional helpers act in an honest and concrete way when dealing with persons who have Asperger´s syndrome.

AIMS: This study was designed to evaluate the effect of gap width and graft placement on bone healing around implants placed into simulated extraction sockets in the mandibles of four beagle dogs. MATERIALS AND METHODS: Four Ti-Unite implants (13 mm x 3.3 mm) were placed on each side of the mandible. Three implants were surrounded by a 1.35 mm circumferential and a 5 mm deep gap around the coronal portion of the implants. A fourth implant was inserted conventionally into both sides of the mandibles as a positive control. The gaps were filled with either Bio-Oss, autogenous bone or with a blood clot alone. The study design was balanced for animal, side and modality. Ground sections were prepared from biopsies taken at 3 months, and computer-aided histometric measurements of bone/implant contact and area of bone within threads were made for the coronal 5 mm. Data were analysed using analysis of variance. RESULTS: The mean bone/implant contact was 9.8 mm for the control and ranged from 9.3 to 11.3 mm for the three test modalities. The corresponding values for area within threads were 1 mm(2) and 1-1.2 mm(2). Modality had a significant effect on both bone/implant contact (F=16.9; P<0.0001) and area within threads (F=16.7; P<0.0001). CONCLUSION: The results of this study suggest that both autogenous bone graft and Bio-Oss played an important role in the amount of hard tissue fill and osseointegration occurring within marginal bone defects around implants.

Violence and aggression is a common problem for staff in different care units. Caregivers often feel frustrated and unsatisfied in their work with these patients. Even caregivers with long experience finds it valuable to get education in management of violent patients. The aim of this literature study was to illuminate staffs experience in meeting with aggresive and violent patients. The method that was used was a literature research, where earlier research findings were read, analysed and put together. Databasis used where Pubmed, Psychinfo and Cinahl. Words that were used in the search was mental health, aggression, violence, abuse, management, staff, coping, and experience. Cause of violence seemed to be the patients sickness. Enviornment could also be the cause of violence. Violence often occured in caring situations, when caregiver where physical close with patients. Caregivers felt anger, shame, guilt and a feeling of being useless. Caregivers doubted their own competence. Nurses felt that their ability to talk and calm patient was ineffective. Staff felt that they had most support from colleagues, family and friends. They wanted to have more support and guidance from managers. There must be actions taken in the area of aggression and violence at work. It can not be taken as an acceptable way to behave, and something that is accepted as a part of the work. Caregivers must report violence to managers to show that it exist. The enviornment must be adjusted to the purpose of care. Caregivers needs education and guidance in meetings with aggresive and violent patients.

To increase the understanding of how individuals total life situation affects their stress level and health has lately more frequently been discussed in different contexts. Furthermore, it is important to have knowledge of power structures that exist under given circumstances in a society to get an increased understanding of how to structure the health promoting work to get the highest possible benefits. People’s work life is essential to their health, since we spend a lot of time at work. The aim of this study was to find out which factors that relate to nursing staff’s health and stress level from a general perspective. Furthermore, which thoughts nursing staff have about improvements of their work and life situation. The intention is that the result can be used as inspiration in the health promoting work within nursing staff workplaces. The method that was used was a quantitative cross-sectional study with a structured questionnaire that also consisted of open questions that gave the respondents the opportunity to give their own thoughts and explanations. In total 118 individuals answered, a response rate of 47 %. The answers were analysed with the statistical software SPSS. The results showed that the most important factors that related to the respondents’ health in a positive way were supportive fellow-workers, high self-esteem and high possibilities of influence at the workplace. The factor that related to low stress level was high age. There were many suggestions of what the employer could do to enable the staff to better combine private life and work life. The most common suggestions were that they wanted to be able to influence their working schedule more and that the employer had a more flexible attitude regarding vacation. To increase the understanding of what affects nursing staffs´ health in both work life and private life, when the total work burden in peoples´ lives is considered, has great relevance to public health science. To achieve this, both a gender and a class perspective must be considered.

Background: Every year, more than 1000 cases of adverse events are reported in the Swedish health care system. These adverse events cost approximately 240 million Swedish kronor each year. By explaining the factors that cause nurses to make mistakes when they have too great a workload, it is hoped the awareness of health care staff will increase. Aim: To perform a literature review which describes factors that can endanger patient safety when nurses experience too great a workload. Method: A systematic literature review encompassing both quantitative and qualitative material. The material in the chosen articles was analysed with a content analysis method. Findings: When nurses experienced too great a workload they do not always follow routines, which had the effect of endangering patient safety. A shortage of nurses and under-manning results in a

workload which suggests patient safety is not always maintained. Conflicts and misunderstandings between nurses and other healthcare staff also contribute to an increased risk of mistakes occurring. Conclusion: The study showed that too great a workload resulted in a decreased patient safety. Not following routines, nursing shortages and staff failing to communicate effectively were factors which could lead to mistakes affecting patient safety occurring.

Studies show that regular, frequent physical activity can lead to a range of health benefits and prevent chronic illnesses. “Exercise on prescription” has emerged from the desire to have a more health promoting approach in the medical service and also to develop more active lifestyles. Evaluations show that practitioners need more knowledge and motivation in order to work with “exercise on prescription” interventions. The purpose of this study was to examine the attitudes towards “exercise on prescription” amongst last-term students on medical training, nurse training, physiotherapist- and occupational therapist training. And also examine if the vocational training has given the prerequisite to work with the method. Quantitative data analysis was used by handing out questionnaires to the students at two universities in the southern part of Sweden. Results show that the students expressed positive attitudes toward exercise on prescription but there is insecurity about their knowledge and readiness to work with it. Conclusions we made were that education can increase the students self-efficacy which we believe can provide for the students’ readiness to work with “exercise on prescription” in the future.

Background: Kristianstad University College in Sweden gives nursing students the opportunity to practice abroad. Nursing students who practice abroad in a developing country enhance experience that affects the student’s future profession, international perspective, personal and intellectual development. Aim: The aim of the study was to describe nursing student’s experiences of practice abroad in a developing country such as Sri Lanka. Method: A qualitative empirical study was implemented. The result and the analysis was based on self written diaries. The data was analyzed with a qualitative content analysis. Results: The result is presented in four themes: The start: everything was new, In the middle of the journey: trying to find daily routines, The end: looking forward and Back in Sweden: to readjust. Experiences as: storm of emotional feelings, to cope with difficult times and a feeling of personal development were presented in the result. Discussion: Performing practice abroad, encountering different cultures and experiencing a personally change can nurture nursing students in their coming quest as nurses. This is germane both in terms of meeting and communicating with patients of various cultural stocks. Furthermore, comprehension concerning receiving information regarding illnesses and also the different phases of the illness itself is facilitated through this experience.

OBJECTIVE: The purpose of the study was to investigate whether osseointegration can occur on rough implant surfaces that previously had been coated with bacterial biofilm. MATERIALS AND METHODS: The premolars on both sides of the mandible in four beagle dogs were extracted. Following 3 months healing, three titanium implants Ti-Unite, Nobel Biocare were partially inserted in the left side of each mandible. Some threads protruded from the tissues into the oral cavity. Plaque accumulated on the exposed part of the implant. Following a 5-week healing period, the contaminated parts of each implant were treated using three different techniques: (1) swabbing with citric acid for 30 s followed by rinsing with physiological saline, (2) cleansing with a toothbrush and physiological saline for 1 min, and (3) swabbing with 10% hydrogen peroxide for 1 min followed by rinsing with physiological saline. The treated implants and one pristine implant (control) were installed to the full implant length on the contralateral sides of the mandibles. Following 11 weeks of healing, the dogs were sacrificed and biopsies were obtained. Ground sections were prepared for histomorphometric analysis. RESULTS: All treatment modalities were associated with direct bone-to-implant contact on the portion of implant surface previously exposed to the oral environment. CONCLUSIONS: The results demonstrate that rough surfaces, which were plaque contaminated and cleaned by different methods, can re-osseointegrate.

This report is a commission from the Care Unit of Hässleholm municipal. The purpose is to illuminate what is distinguish for contact persons at sheltered housing in the Municipal of Hässleholm? It contains three questions at issue. What are the expectations of the contact men? What information is given? How is communication between the professional categories working out?

The report also contains a background with a brief Swedish history in care of older people. It talks about the meaning of contact persons and the meaning of quality assurance. It also contains other municipal´s study about this subject. A scientific article is included and also a short information about the Municipal of Hässleholm.

The method that has been used is a Qualitative method with interviews. The selection of respondents are pensioners, relatives, assistant nurses, nurses, physiotherapist, occupational therapist, unit managers, care managers and the Care Unit head manager of the municipal of Hässleholm.

The aim of this study was to examine the differences in experience of the dental hygienist education between newly examined dental hygienists born abroad and born in Sweden. A quantitative study was performed.

The questionnaire was sent out to all dental hygienist (n=162) examined in Sweden 2006, except newly examined dental hygienists in Karlstad University which is a distance education. The number who answered after the reminder was 102 respondents, 24 born abroad and 78 born in Sweden. The questionnaire contained 20 open and closed questions.

The result of this study showed that there was no significant difference between respective groups concerning the experiences of the dental hygienist education. The majority answered that the teachers were accommodating and that a good solidarity existed between the classmates. The respondents stated that the communications between the teachers and classmates were positive. Most of the respondents in respective group find that the education fulfilled there expectations.

The conclusion of this study was that the majority of the newly examined dental hygienists 2006 had a positive vision about the dental hygienist education.

The high prevalence of chronic pain (duration >3 months) reported from different populations indicates a public health problem. Knowledge of the long-term course of chronic non-malignant pain is incomplete and scarce.This paper describes a follow-up of a cohort recruited from a survey in the general population. The cohort (n=214) consisted initially of individuals with widespread or located (neck-shoulder) pain or without chronic pain. The individuals were initially examined and replied to questionnaires on pain, social factors, lifestyle, medication and health care after two and 12 years. The deaths during the period were obtained from the population register. Complete data exist for 77% of the eligible individuals.After 12 years one-third of the individuals initially without pain reported chronic pain, and among those with initial chronic pain 85% still reported chronic pain. The number of painful areas was the strongest predictor of chronic pain 12 years later (OR 15.8; >3 locations vs. 0) whereas a social factor (having a close friend) decreased the risk (OR 0.44). The onset of chronic pain during the same period was related to the physical workload (work with bent positions; OR 5.31; yes vs. no). Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups. The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain. The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.

OBJECTIVE: To study the relationship between reported chronic pain and the level of serum urate (SU) among women with various diagnoses of the musculoskeletal system. METHODS: Consecutive female patients (aged 20-70 years, n = 124), at rheumatology and rehabilitation practices, with chronic musculoskeletal pain of different origins were followed for 1 year after an initial survey of pain, lifestyle, quality of life, and disability. Repeated blood samples (including urate, creatinine, cholesterol, and glucose) were analysed. Multiple regression analysis was performed to explain initial variations in SU level in relation to pain and confounding factors. RESULTS: The level of SU was increased among individuals with widespread pain (>5 locations) independent of underlying diagnoses compared to those with fewer pain sites (270.5 vs. 241.2 micromol/L). Serum creatinine, body mass index (BMI), the number of pain locations, and sleep disturbances independently contributed to the SU level and explained 43% of the variation in SU. Individual variation in SU during 4 months was low. CONCLUSIONS: Epidemiological data on the relationship between the extent of body pain and SU were confirmed in a clinical setting. Besides known factors such as impaired renal function and obesity, widespread pain and sleep disturbances were related to an increase in SU. Medication and alcohol intake could not explain the findings. Longitudinal studies are necessary to elucidate whether the level of SU has any implications for the prognosis of chronic pain.

The purpose of this study was trying to understand and explain why young people with psychological problems injure themselves by cutting, scratching and burning. The study also examine if self- injuring behaviour is an increasing problem in our society. Self-injuring behaviour is a phenomenon with dissimilar definitions. There are as many ways of injuring yourself as there are individuals who injure themselves. In this study six professionals, who through their work have contact with self- injuring people, have been interviewed. Their own view of self- injuring behaviour was put in comparison with the literature. It was found that despite their dissimilar educations and experiences of self- injuring behaviour they had a similar view of the phenomenon. The most common definition of a self- injuring behaviour was cutting, scratching or burning yourself. Although they don’t know the reason for it, the literature as well as the informants seem to agree that self-injuring behaviour is increasing in society. They emphasize that media, through the attention given to the phenomenon during the last years, could have an effect on the increase. Two of the most common reasons why an individual chose to hurt him- or herself, seem to be reduction of anxiety and/or seeking attention. The most important result found in this study is why people maintain this behaviour and what functions self-injuring behaviour serve them.

Background: Heart ischemia is a disease affected by behaviour, lifestyle and heredity. The disease is more common in the western world and the number of those who suffer increases. The mortality has reduced thanks to that medical resources and knowledge have approved. Purpose: The purpose of this study of the literature was to find out what patients experienced emotionally at an acute heart attack. Methods: A study of literature where scientific articles has been refereed and analyzed, then resulted into five categories presented in the result. Results: Studies shown that many of the patients have a depression and had experienced a lack of support after the hospitalisation. Conclusion: Needed in the sick care is that the nurse is able to take time for an individual care that looks through the medical diagnostic.

Background: Fibromyalgia is a psychosomatic disease that emerges without any known cause. For a long time, it has been believed to be a part of the menopause. Between 0,7 and 4,8 % of the women in Scandinavia are diagnosed. The most obvious symptom is pain. Aim: The aim with the literature review was to describe how women with fibromyalgia experience their lifesituation. Method: A systematic literature review has been implemented, containing ten scientific articles. These where reviewed and analyzed according to Forsberg & Wengström (2003). Thereafter the texts were coded and themes emerged which were presented in the results. Results: Women who are diagnosed with fibromyalgia experience they were not believed or taken seriously by their surroundings. This affects relationships negatively. In the families, the women were considered lazy which created feelings of guilt within them. Friends did not understand that they were sick in terms that fibromyalgia can not be seen on the outside. Co-workers showed a lack of understanding and the sick women felt alienated. Not even healthcarepersonel believed the diffuse symptoms. To be able to handle the disease, the women created different copingstrategies. Discussion: It seemed important that diagnoses were made in order to help the women to handle the disease. For nurses to treat patients with respect instead of disbelieve, Kim’s (2000) domains might be a model of interaction to work from.

Background: Patients with self-harm seek hospital care when something traumatic occurred. Self-harm was a way to cure pain and was expressed overdose, cutting, or by swallowing objects. They described that the staff were derisive, didn’t show empathy and engagement. Aim: The aim was to describe factors that effects staffs answer to self-harm behaviour through their perspective. Method: A literature review search has been carried out. Based from the aim a search in different databases was made. The articles were analyzed, were identified, coded and sorted in categories. Result: The result was presented in five categories. The result indicates that factors like biases and lack of contingency was a common response by the staff. Factors like support and training were essential factors to make the personnel get positive attitude towards self-harm behaviour. Discussion: The refutation of self-harm behaviour could improve by Watson’s theory, training and supervision. By asking the right questions, be supportable and honest the staff could reduce their negative attitude. Conclusion: Staff needs more knowledge regarding their own way of acting, understanding and knowledge of self-harm in order to be able to face patients in a professional way.

Background: The HIV-pandemic is a global concern. Everyday about 6000 adolescents become infected with HIV. The HIV-prevalence in Zambia among adolescents, between 15-24 years, were 3,8% for men and 12,7% for women in year 2005. Aim: The aim of this study was to explore adolescents` knowledge, attitudes and beliefs about HIV/AIDS in Livingstone in Zambia. Method: The sample consisted of 67 adolescents, 33 males and 34 females in age 15-24 years. The study design was mainly quantitative, using a questionnaire-based approach with both closed and opened questions. Data was analyzed by using SPSS and content analysis. Result: The result indicates a general high level of knowledge. The narratives expressed both a deep worry for the severity of the HIV epidemic, but also indicating optimism for change. Conclusion: The participants were hesitant concerning change. The complexity of the issue was clear, information about condoms and change of attitudes and beliefs are important, but in addition poverty has to be acknowledged in order to be able to fight HIV.

Background: Schizophrenia includes symptoms suchlike misconceptions, rage and apathy and has a high prevalence of suicide. Next of kin often gets a reduced quality of life because of the strains they are exposed to. They need support from health services so they can manage to be a part of the ill person’s life. Aim: Describing experiences of being next of kin to a person with schizophrenia and there by increase the nurse’s understanding to this group of individuals. Method: An ordinary literature review of empirical studies. Findings: The negative experiences were dominated and included e.g. worry about outbursts of rage, sadness for the changed personality of the mentally ill person, feelings of guilt for not being ill and lack of support from health carers. Positive experiences were described e.g. as hope for the future, acceptance of the illness, support from friends and personal development. Conclusion: To be able to support and guide next of kin, nurses and other health carers need an increased knowledge and understanding of their situation. Adequate support is obtained by being sensitive and open but also to have readiness for the needs of next of kin.

For a long period of time there has been an extensive documentation of how things are presumed not to be at our workplace. However there is little knowledge on how it is supposed to be, what makes us feel good and what makes us retain our well-being. The aim of this study was to survey the attitudes towards factors of well-being at the workplace among personnel at four institutions at Kristianstad University. The work method used in this study is quantitative and a questionnaire survey was carried out to produce an overall picture. The majority considered praise from manager and the opportunity of development discussions of great importance. During the development discussion the majority considered feedback on work achievements the topic of most importance to discuss. Stress management was found to be the pre-eminent benefit to be offered from the employer. Women had a more positive attitude towards factors that promote health in the relationship between the co-workers. In general women also had a more positive attitude towards factors that promote health in the assignment. The result of our study raises attitudes towards health promoting factors, and could indicate the direction for pursued health promoting work in the workplace. To enable an organization, and its employees, to develop and grow according to their attitudes, they will need opportunities to reflect and learn.

Growing up with a functionally disabled sibling can bring joy and positive experiences, but also complications. The purpose of this paper is to describe the experience of growing up with a functionally disabled sibling. I have chosen to focus the examination on how individuals with functionally disabled siblings believe they have been affected by their relationship to their functional disabled sibling and whether it has continued to affect them in adulthood.

The examination was qualitative and conducted through interviews. The results showed that siblings of functionally disabled individuals tend to grow up with strong feelings of responsibility and anxiety that continue to affect them into adulthood. The investigation further showed that all interviewed chose occupations in care, and that they give great attention to relationships to others. I have used Maslow's hierarchy of needs as a comparison to examine whether these needs are affected by the special relationship. My conclusion is that individuals with functionally disabled siblings are affected in various ways by the special situation in their upbringing. Those interviewed for the purpose of the examination have many common experiences that can be traced to their upbringing, though there were also in some cases differences between the subjects where experiences diverged. There is nothing in the results of my examination that indicate that the needs according to Maslow would be affected in a negative way. Hardship in childhood and adolescence has given experiences that have enriched the interviewed subjects. They have retained a feeling of identity and developed through the experience of their relationship with a functionally disabled sibling.

The general aims of this thesis were to evaluate the usefulness of an oral assess¬ment guide and to determine the oral health status among frail patients in hospital settings. A further aim was to analyze possible factors that may be associated with oral health status, with special focus on the relationship between oral health and nutritional status among elderly rehabilitation patients. The Oral Assessment Guide (OAG) was used in patients with haematological malignancies undergoing chemotherapy. In further studies a Revised Oral Assessment Guide (ROAG) was used among geriatric rehabilitation patients. The inter-rater reliability of the OAG between registered nurses at the ward and a dental hygienist (DH) was good, as well as between a registered nurse and a DH using ROAG. Problems in the oral cavity were detected in all patients with haematological malignancies undergoing chemotherapy. Problems related to mucous membranes, teeth and/or dentures were most frequent. Oral health problems were also a frequent finding among the geriatric rehabilitation patients. The frequency of oral health problems was significantly lower at discharge compared to admission. Oral health problems were more often found among patients that stayed for longer periods at the hospital, were more dependent on help with daily activities and suffered for dysphagia, than among the healthier patients. Oral health problems were more common among the patients being at risk of undernourishment, suspected to be or severely undernourished (UN), than among the well-nourished patients. Problems in oral health status were significantly associated with the occurrence of respiratory diseases, living in special accommodation, being UN and being a woman. The highest Odds Ratio (OR) was found in problems with gums in relation to the occurrence of respiratory diseases (OR 8.9; 95 % CI 2.8-27.8). OAG as well as ROAG were found to be useful for assessing oral health status in frail patients at hospital. Oral health problems were a frequent finding among the patients. The use of an oral assessment tool on a routine basis may facilitate the detection of problems which otherwise can be hidden, and can serve as a guide for initiating individualised oral health procedures.